Self-report of self-disclosure statements for stuttering

Abstract

Purpose:

To (1) analyze verbatim wording used by adults who stutter (AWS) to self-disclose stuttering, (2) determine contexts in which AWS may self-disclose, (3) examine the use of self-disclosure by AWS about other aspects of their identity, and (4) investigate the ways in which speech-language pathologists (SLPs) develop self-disclosure statements with AWS.

Method:

Web-based questionnaires were administered to AWS (N = 42) and SLPs (N = 33) who work with AWS. The AWS questionnaire asked about the verbatim wording of self-disclosure statements used by AWS and the contexts in which they utilize them. For SLPs, the questionnaire probed how and why they work with AWS to formulate self-disclosure statements. Responses were openly coded and then funneled into concepts for analysis.

Results:

The majority of AWS provided verbatim self-disclosure statements which were educational in nature. However, when responding to fixed choices and when reporting on self-disclosing other aspects of their lives, the majority of participants selected a direct statement. The majority of AWS reported that they self-disclose when interviewing for a job. SLPs reportedly instruct their clients to use educational self-disclosure statements. SLPs also reported that they use an individualized approach to brainstorming self-disclosure statements. Finally, SLPs reported that they find self-disclosure beneficial because it facilitates self-empowerment for AWS.

Conclusion:

AWS may benefit from learning about the type of self-disclosure statements and the contexts in which other AWS chose to disclose. Additionally, SLPs who work with AWS may benefit from the reported procedures for and types of self-disclosure statements formulated by AWS.

1. Introduction

Stuttering is a complex communication disorder with a multifactorial etiology, including physiological, environmental, speech-language, and psychological factors (e.g., Bloodstein & Bernstein Ratner, 2008; Conture, 2001; Guitar, 2014; Smith & Weber, 2017). People who stutter have been associated with negative personality characteristics and qualities, such as being timid, shy, unintelligent, and producing distracting speech (e.g., Boyle, 2013; Lass et al., 1992; Daniels, Panico, & Sudholt, 2011; Franck, Jackson, Pimentel, & Greenwood, 2003; Hurst & Cooper, 1983; Lass, Ruscello, Pannbacker, Schmitt, & Everly-Myers, 1989; Ruscello, Lass, Schmitt, & Pannbacker, 1994; Silverman, 1982; Walden & Lesner, 2018; Woods & Williams, 1971; Yairi & Williams, 1970). These pervasive misconceptions and stereotypes are inaccurate (e.g. MacKinnon, Hall, & MacIntyre, 2007; St. Louis & Tellis, 2015) and play a role in the creation of stuttering stigma.

1.1. Stigma

Public stigma related to stuttering has been well-documented (Boyle, 2016) and has implications for the person who stutters (Corrigan & Rao, 2012). When internalized, these feelings of self-stigma, which are associated with feelings of disapproval, may lead to behavioral impacts including social isolation (Corrigan & Rao, 2012), role entrapment (Gabel, Blood, Tellis, & Althouse, 2004; Gabel, Hughes, & Daniels, 2008), feelings of anxiety, fear, and lowered self-esteem (Alm, 2014; Boyle, 2017), and negative self-thoughts (Boyle, 2013; Lowe et al., 2017). Recently, Boyle and Fearon (2018) explored the role of self-stigma in health satisfaction for adults who stutter (AWS). They found that among individuals who stutter, higher self-stigma correlated to lower physical health including gastrointestinal problems, headaches, and issues with sleep. Additionally, for those who experience self-stigma, chronic stress was found as a barrier to their own physical health. Finally, the more awareness of social stigma experienced, the higher their risk for physical health issues. Those who reported higher awareness of public stigma also reported more discomfort seeking healthcare services as well as adverse health outcomes (Boyle & Fearon, 2018).

1.2. Self-disclosure

Self-disclosure, or self-advertising, is a strategy used by people who experience marginalization and stigmatization that enables them to share personal information about themselves to a communication partner. Previous research has explored the use of self-disclosure statements in disorders such as mental illness, (Corrigan, Kosyluk, & Rüsch, 2013), PTSD (Bolton, Glenn, Orsillo, Roemer, & Litz, 2003), eating disorder (Basile, 2004), anxiety (Meleshko & Alden, 1993), and HIV (Simoni et al., 1995). Self-disclosure has also been utilized as a therapeutic strategy to reduce stigma associated with stuttering (e.g., Murphy, Yaruss, & Quesal, 2007).

Recent research continues to support the positive effects of self-disclosure for adults and children who stutter (Byrd, Croft, Gkalitsiou, & Hampton, 2017; Byrd, McGill, Gkalitsiou, & Cappellini, 2017; Byrd, Gkalitsiou, McGill, Reed, & Kelly, 2016). Byrd, McGill et al. (2017) asked 173 randomly assigned participants to watch two of four possible videos (i.e., male self-disclosure/no disclosure and female self-disclosure/no disclosure) and complete a questionnaire about their observations. Each video was the same except that in the self-disclosure condition, the statement “Just so you know, I sometimes stutter, so you might hear me repeat some words/sounds/phrases” was included at the beginning of the video (Byrd, McGill et al., 2017, p. 4). Observers were more likely to rate speakers who self-disclosed as more friendly, confident, and outgoing as compared to those who did not disclose their stuttering. Speakers who did not self-disclose were viewed as unfriendly and shy as compared to speakers who did self-disclose.

Similar, positive results have also been associated with children who stutter who self-disclose. Byrd et al. (2016) randomly assigned 130 participants to watch two of four possible videos (i.e., male self-disclosure/no self-disclosure and female self-disclosure/no disclosure). Similar to Byrd, McGill et al. (2017), observers were more likely to view those who self-disclosed as being more friendly; observers reported that they were less distracted when the person who stutters self-disclosed.

Byrd, Croft et al. (2017) further explored the utility of self-disclosure by investigating the benefits of various types of disclosure statements. Participants (n = 338) were randomly assigned to view one of six possible video choices (i.e., adult male informative self-disclosure, adult male apologetic self-disclosure, adult male no self-disclosure, adult female informative self-disclosure, adult female apologetic self-disclosure, adult female no self-disclosure). Observers were asked to complete a questionnaire immediately after watching the videos. More positive observer ratings were noted for informative self-disclosure as compared to no self-disclosure statements. Of note, as compared to not disclosing at all, self-disclosure statements that were apologetic in nature did not result in more positive ratings. These results suggest that an informative self-disclosure statement may yield the most positive listener perceptions. Taken together, these results support that self-disclosure is a valuable tool to increase positive listener perceptions for both adults and children who stutter.

While previous research has investigated the use of self-disclosure to positively impact observers’ perceptions of persons who stutter (e.g., Byrd, McGill et al., 2017, 2016; Healey, Gabel, Daniels, & Kawai, 2007), there is no published research investigating the verbatim wording of self-disclosure statements used by AWS and the contexts in which persons who stutter choose to self-disclose. Furthermore, there is little information about how and when people who stutter may use a disclosure statement to reveal other information about themselves such as a mental illness, a family member’s death, or being a part of the LGBTQ community. Beyond these aspects, there has been minimal discussion among speech-language pathologists (SLPs) who work with AWS as to their clinical manner in generating a disclosure statement with their clients. Therefore, an exploration of the verbatim wording of self-disclosure statements, the situational contexts in which these statements are used by AWS, and the methods which SLPs use to support the development of these statements is warranted.

1.3. Purpose

The purposes of this study are to (1) analyze the verbatim wording used by AWS to self-disclose their stuttering, (2) determine the contexts in which AWS may use a self-disclosure statement, (3) examine the use of self-disclosure by AWS about other aspects of their life in addition to stuttering, and (4) investigate the ways in which SLPs develop self-disclosure statements with their adult clients who stutter.

2. Method

2.1. Web-based questionnaires

Two web-based questionnaires were developed: one for AWS and one for SLPs who work with AWS. These questionnaires and this research project were approved by the authors’ Institutional Review Board #174094. Recruitment was conducted through social media (e.g., Facebook groups and pages, Reddit), stuttering related web pages, word of mouth, and clients currently receiving speech therapy services at the authors’ university.

2.2. AWS questionnaire

2.2.1. Participants

Forty-two participants were recruited to complete the questionnaire from February through November 2017. The participants were self-reported AWS (n = 42 [33 men, 9 women]) ranging in age from 18 to 74 years. Participant demographics are listed in Table 1.

Table 1.

Participant characteristics.

Demographic	Participants
N	42
Men	79%
Race (Hispanic or Latino)	9.5%
Race (Asian / Pacific Islander)	12%
Race (White)	32%
Race (Unreported or Other)	46.5%
College degree or higher	69%
English as a first language	71%

2.2.2. Questionnaire description

Participants were asked questions such as “Please describe verbatim your self-disclosure statement” and “Please choose which of the following best matches your self-disclosure statement.” The questionnaire also asked participants to report interactions when they self-disclose (e.g., speaking with cashiers), as well as when during the interaction they would typically self-disclose (e.g., beginning, end). Finally, the questionnaire asked participants to provide information about different aspects of their identity that they may disclose (e.g., mental illness), as well as how they disclose (e.g., simple word cues, jokes, preface statements). See full AWS questionnaire in Appendix A.

2.3. SLP questionnaire

2.3.1. Participants

Participants were 38 SLPs who work with people who stutter. Five participants were excluded as they reported that they only work with children who stutter. Thus, participants included in the current study were 33 SLPs who work with AWS. Table 2 describes the settings in which these SLPs reportedly work.

Table 2.

SLP Participant setting demographics.

Demographic	Participants (N)
N	33
Setting - Private Practice	16
Setting - University Clinic	6
Setting - Clinic	10
No response	1

2.3.2. Questionnaire description

A 15-item web-based questionnaire was created to investigate how SLPs introduce, educate, and assist clients in the formation of self-disclosure statements. Participants were asked questions about their geographical location, the setting of their clinical practice (e.g., private practice, school, university) and the ages of their clients (e.g., school-age children, adults). Participants were then asked questions specific to stuttering and self-disclosure such as, “What do they [adult clients who stutter] say for their self-disclosure statement?”, “How do you approach developing a self-disclosure statement?”, and “Why do you find a self-disclosure statement applicable to your intervention?” See full SLP questionnaire in Appendix B.

2.4. Data coding, analysis, and reliability

Finn and Felsenfeld (2004) report that qualitative research designs are appropriate for exploring participants’ individualized perceptions and perspectives of their experiences. Thus, a qualitative approach to data coding and analysis was implemented to understand the common experiences expressed by AWS and SLPs who work with AWS related to self-disclosure.

To analyze the data for both questionnaires, each participant response was openly coded using a process that includes brainstorming to consider all possible meanings and ensure careful observations of all answers. This data coding and analysis was done without a priori hypotheses or preconceived categories in order to reduce coder bias (Corbin & Strauss, 2008). Initially, participant responses were analyzed individually. Then, after open coding, these codes were broadly examined for similar ideas and thoughts expressed by the participants. Similar codes were then funneled into concepts. This open-ended approach to the coding of participant responses allowed for an organic observation of themes related to self-disclosure. Questions that included fixed choice results were inherently coded and are reflected in the results section.

Consistency and reliability of coding was achieved in the following manner: After the initial stage of open coding was independently conducted, the results were verified among the authors who performed a joint line-by-line review of participant responses. These codes were funneled into categories, agreed upon by the first and third authors. After the authors completed this collapsing of data, the categories were reviewed and discussed by all authors and any discrepancies were resolved in these discussions. Thus, all participant responses were coded by at least two investigators, with all investigators participating in the coding and/or category creation. These categories were then examined and described in an effort to reflect the key components of the AWS and SLP participants’ experiences with self-disclosure statements.

3. Results

3.1. AWS questionnaire

3.1.1. Verbatim self-disclosure

For the open-ended question “Please describe verbatim your self-disclosure statement,” 36 (94.74%) participants provided a verbatim self-disclosure statement they use in their lives. Two responses were coded as irrelevant and were excluded from further analysis. The 36 data points were initially analyzed and coded using 12 codes. The 12 codes included informational, humor, situational, direct, apologetic, guilt, advising the listener, educating the listener, straightforward, sharing relevant information, asking for listener patience, and use of media examples. These codes were then funneled into three concepts: apologetic, educational, and direct statements. Apologetic statements included keywords and phrases that portrayed being regretful of their stuttering or apologetic to their listener such as, “sorry,” “please bear with me,” “excuse my stuttering,” and “I hope you don’t mind.” Educational statements contained words or phrases that included information about stuttering or references to outside sources (e.g., movies or therapy) such as “I need some more time,” “have patience,” “sometimes the words don’t come out as I would like [them] to come out,” “I am taking speech therapy,” and “I sometimes stutter, or block - where I have trouble getting a sound out.” Direct statements included phrases that were straightforward and contained no education about stuttering or apologies of their stuttering, such as “I am a person who stutters,” “I stutter sometimes,” and “By the way, I stutter.” (Table 3)

Table 3.

Concepts created for responses to the question “Please describe verbatim your self-disclosure statement.”.

Concept	Description	Examples
Educational	Statements included information about stuttering disfluencies/types or strategies used by the person who stutters while speaking.	“I am a stutterer. It’s a speech problem…All I want you to do is have patience, if I take too long while I speak.” “I sometimes stutter, or block - where I have trouble getting a sound out, so you may hear me do so, or see me look like I’m trying to get a word out.”
Apologetic	Statements included keywords and phrases that portrayed the AWS being regretful of their stuttering or apologetic to their listener.	“Please bear with me.” “I’m sorry. I stutter.”
Direct	Statements that were straightforward and included no education about stuttering or apologies of stuttering.	“I am a person who stutters.” “I stutter.” “By the way, I stutter.”

Ninety percent (38 of 42) of AWS reported they use a self-disclosure statement related to stuttering. Of the 34 verbatim responses, seventeen (53%) participants provided educational statements. Ten (31.25%) participants reported using direct statements. Eight (25%) reported they use statements including apologetic words. When filtered by gender, four (50%) females provided educational statements, three (37.5%) females provided an apologetic statement, while two (25%) reported using direct and. In contrast, 13 (50%) men reported using educational statements, seven (30.7%) reported using direct statements, while five (19.2%) men provided apologetic statements.

3.1.2. Fixed-choice self-disclosure

Thirty-seven participants responded to the question “Please choose which of the following best matches your self-disclosure statement.” Twenty-two (59.5%) participants selected “My name is ______ and I’m a person who stutters.” Eleven (26.2%) participants selected the statement “My name is ______ and I stutter. Please bear with me as speaking is sometimes difficult for me.” Finally, four (10.8%) participants stated they use an educational self-disclosure statement similar to “My name is ______ and I stutter. You may hear me repeat or prolong sounds and syllables as I speak. If there is anything I say that you do not understand, please let me know and I will be happy to say it again.” When filtered by gender, five of nine (55%) females selected an apologetic statement, while four (44%) selected direct statements. No females selected educational statements in this question. In contrast, 18 (64.3%) men selected direct statements, six (21.4%) men selected an apologetic statement, while four (14.3%) selected educational statements.

3.1.3. Self-disclosure contexts

Thirty-eight participants responded to the question “In what sorts of interactions have you used a self-disclosure statement?” Participants were given the option to select more than one response to this question. The majority of participants (57.9%, n = 22), stated they self-disclose when interviewing for a job. Additionally, 47.3% of participants (n = 18) reported they self-disclose when meeting new potential friends and when talking on the telephone. Fewer than 35% of participants reported that they self-disclose when meeting co-workers, starting a project with a group (work or school), on a first date, meeting a significant other’s family, and when speaking with a cashier.

Participants were also given the option to select more than one response to the question “When during these interactions do you typically self-disclose?” Twenty-three (60.5%) AWS stated they self-disclose at the beginning of an interaction. Additionally, 31.6% of participants (n = 12) reported they self-disclose in the middle of an interaction, 18.4% of participants (n = 7) stated they self-disclose only after knowing someone for a while, 18.4% of participants (n = 7) stated they self-disclose when they are introduced to someone new, and 5.3% of participants (n = 2) stated they self-disclose at the end of an interaction. When filtered by gender, five females (62.5%) reported disclosing at the middle of an interaction, while three (37.5%) females reported disclosing at the beginning of an interaction. No females reported self-disclosing at the end of an interaction. In contrast, 20 (66.7%) males reported disclosing at the beginning of an interaction, while eight (26.7%) reported disclosing at the middle and two (6.7%) reported that they disclosed at the end of an interaction.

3.1.4. Self-disclosing other aspects of identity

Forty-two participants responded to the question “Have you had the experience of having to disclose an aspect of your identity (not including stuttering) that you felt might not be accepted by others?” The majority of participants (52.4%, n = 22), answered “yes” that they have disclosed other aspects of their identity. Additionally, 16.7% of participants (n = 7) answered “not sure” to the question, yet four participants provided answers of what they have disclosed about themselves despite having previously reported that they were unsure whether they had disclosed about other aspects of their identity.

Twenty-five participants responded to the question “Which of the following have you disclosed?” Thirty-two percent of participants (n = 8) reported they self-disclose belonging to the LGBTQ community. Additionally, 28% of participants (n = 7) reported they self-disclose the loss of a family member, and 24% of participants (n = 6) responded they self-disclose a mental illness.

When asked the question “How do you typically disclose these aspect/s of your identity?,” direct statements were reported by 44% of participants (n = 11) as the typical manner of self-disclosing. Additionally, 28% of participants (n = 7) reported self-disclosing using simple word cues (e.g., “my boyfriend…”), and 24% of participants (n = 6) reported self-disclosing using preface statements (e.g., “Having lost my mom…”) and jokes (n = 6).

3.2. SLP questionnaire

3.2.1. SLP report of self-disclosure statement type

For the open-ended question, “What do they [AWS] say for their self-disclosure statement?,” 28 SLPs provided answers, with one coded as irrelevant. The remaining 27 data points were initially analyzed and coded using 14 codes. The 14 codes included client comfort, using a variety of words, client focused, education, communication partner’s patience, apologetic, situational, role play, therapy, humor, direct, providing tips for positive communication, self-reflection, and voluntary stuttering. Codes were then funneled into six concepts: educational, communication advice, direct, apologetic, individualized, and situational. Educational self-disclosure statements included key words and phrases which provided information about stuttering disfluencies or strategies used by the AWS such as, “Sometimes I have bumpy words.” and “Sometimes it just takes me a little bit longer to say what I need to say.” Communication advice responses included educational information or tips for the communication partner (e.g., be patient, allow time for AWS to speak). Apologetic statements contained keywords and phrases that portrayed the AWS being regretful of their stuttering or apologetic to their listener, such as, “Please bear with me.” were noted. Direct statements included phrases that were straightforward and did not include education about stuttering nor apologies of stuttering, such as, “I am a person who stutters.”, “I stutter.” and “By the way, I stutter.” When an SLP did not provide verbatim self-disclosure statements, but reported that they work with their clients to individualize their statements to fit their needs, these were coded as individualized statements (e.g., “Each client formulated a statement that feels comfortable for them.”). Lastly, when SLPs did not provide verbatim self-disclosure statements, but instead referenced that statements created by clients were dependent on the context (e.g., where, when, audience), these responses were coded as situational statements.

The majority of SLPs (37%) reported that their clients use an educational type of self-disclosure statement. Additionally, 33.3% SLPs reported that their clients use individualized statements, 25.9% used situational, 22.2% used direct, 18.5% used communication advice and 3.7% used apologetic. See Table 4 for concepts definitions and examples.

Table 4.

Concepts created for responses to the question “What do they (AWS) say for their self-disclosure statement?”.

Concept	Description	Examples
Educational	Statements included information about stuttering disfluencies/types or strategies used by the PWS while speaking.	“Sometimes my words get stuck.” “Sometimes it just takes me a little bit longer to say what I need to say.”
Communication Advice	Statements included educational information or tips for the communication partner to while the AWS is speaking.	“Be patient.” “I might need some extra time to answer. ”
Apologetic	Statements included keywords and phrases that portrayed the AWS being regretful of their stuttering or apologetic to their listener.	“I’m sorry.” “Please bear with me.”
Direct	Statements that were straightforward and included no education about stuttering or apologies of stuttering.	“I am a person who stutters.” “I stutter.” “By the way, I stutter.”
Individualized	SLPs did not provide specific examples of statements, instead referencing that clients individualize statements and statements used depend on the situational.	“Each client formulated a statement that feels comfortable for them.”
Situational	SLPs did not provide specific statements, instead referencing that statements created by client’s were dependent on the situation (e.g., where, when, audience).	“Depends on the client and the situation.”

3.2.2. Self-disclosure statement development

For the open-ended question “How do you approach developing a self-disclosure statement?,” 29 SLPs provided answers. Data was initially analyzed and divided into 18 codes. These 18 codes were: brainstorm information, client comfort, client’s own their stuttering/take control, self-exploration and discussion, ask about their support system, statements are not apologetic, assessment of attitudes/emotional state/readiness, role play pros and cons of disclosing, identification of self in relation to stuttering, explain that statements take the pressure off, wait for difficult speaking situations before discussing statements, liberating/decreasing anxiety, provide some suggestions, reduce fear, acceptance, provide resources, introduce stories about previous clients, provide tips for the listener. Codes were then funneled into eight concepts: comfort, readiness, brainstorm, control & ownership, practice, situational, resources, and group therapy. See Table 5 for concept definitions and examples.

Table 5.

Concepts created in response to the question “How do you approach developing a self-disclosure statement?”.

Concept	Description	Examples
Comfort	Approaches taking into account the client’s comfort with using self-disclosure statements.	“Working on a statement that the client feels comfortable using.”
Readiness	Approaches taking into account the client’s readiness to use self-disclosure statements.	“I begin with an attitudes assessment to help me be aware of the patient’s awareness of and ability to discuss his/her stuttering.”
Brainstorm	Approaches included the clinician and client brainstorming statements that work for the client.	“Brainstorm what information they want their listener to know about themself and their stuttering.”
Control & Ownership	Approaches included discussing clients taking control of situations by disclosing, owning their stuttering, references to making no apologies about their stuttering, and reducing fear or anxiety around stuttering.	“Remember it’s not an apology.”
Practice	Approaches included some form or practicing self-disclosure statements by role-playing different situations in clinic and practicing in real situations outside of clinic.	“Practicing different disclosure statements in different situations.”
Resources	Approaches that involved SLPs sharing stories or introducing clients who have used self-disclosure statements successfully and providing articles about self-disclosure in stuttering.	“Usually I share stories about how other clients disclosed and let the client choose what feels right for them. ”
Situational	Approaches included SLPs asking clients to provide specific situations they may want to use a self-disclosure statement, and brainstorm statements together.	“We discuss a specific situation where disclosure could be helpful, and consider what the client might be worried the person would think if he/she stuttered and did not disclose. ”
Group Therapy	Approaches included creating groups with adults who stutter to discuss stuttering and self-disclosing.	“We have a group discussion on the concept of “openness,” sharing something you might feel uncomfortable about.”

Approximately 27% of SLP participants reported that brainstorming and cueing about control/ownership of stuttering was the approach they used with their clients. Additionally, 24.1% of SLPs reported that they considered the situation in which a client may choose to self-disclose. SLPs (17.2%) reported practice was included in their development of self disclosure statements. Furthermore, 12.8% of SLPs reported that they considered the client’s comfort and readiness in developing a self-disclosure statement. SLPs (10.3%) reported that resources were involved in their development of disclosure statements with clients who stutter. Finally, 6.9% of respondents also reported that group therapy was a consideration in their client’s development of disclosure statements.

3.2.3. Application to intervention

For the open-ended question “Why do you find a self-disclosure statement applicable in your intervention?,” 28 SLPs provided answers, with one coded as irrelevant. The 27 data points were initially analyzed and coded using 18 codes. These 18 codes were: build acceptance and advocacy, empowerment, combat avoidance behaviors, own their stuttering/control it, decrease anxiety and fear, ease the tension and pressure of stuttering, build confidence, generalize skills, help patients, embrace stuttering, improve communication and empathy, make it comfortable to speak, make successful and easier communication interactions, acceptance to reduce internal struggles, educate people who don’t stutter, desensitization, help listener and get a favorable response from listeners, clients become more fluent. Codes were then funneled into five concepts: self-empowerment, reducing fear and anxiety, reducing avoidance behaviors, client success and communication. See Table 6 for concept definitions and examples.

Table 6.

Concepts created in response to the question “Why do you find a self-disclosure statement applicable in your intervention?”.

Concept/Category	Description	Examples
Self-Empowerment	Answers included information about PWS gaining acceptance of their stutter, owning it, controlling it, being an advocate, and feeling confident, comfortable, or empowered through the use of self-disclosure statements.	“Builds acceptance and advocacy skills.”
Reducing Fear & Anxiety	Answers included using self-disclosure to reduce anxiety or fear surrounding stuttering and talking to others.	“…many clients find that they are less anxious…”
Reducing Avoidance Behaviors	Answers included using self-disclosure to reduce avoidance behaviors (e.g., concealing stutter, avoiding talking, specific situations, or words).	“Because there is no cure for stuttering, so not disclosing will likely mean that any behavioral techniques learned will be used as a strategy to conceal the observable behaviors of stuttering and lead to more avoidance practices. “
Client Success	Answers included SLPs citing previous clients who found self-disclosure helpful.	“I have found this to be extremely helpful for some patients.”
Communication	Answers included using self-disclosure statements to improve overall communication with communication partners, education about stuttering, and reducing communication pressures.	“It is another tool clients can use to facilitate successful communication.”

Similar to the previous questions, some SLPs answers contained multiple concepts and were coded as such. The majority of SLPs (57.1%) reported that self-disclosure was applicable to their clients by facilitating self-empowerment. Additionally, SLPs reported that self-disclosure enhanced communication (39.3%), reduced fear and anxiety (32.1%), reduced avoidance behaviors (28.6%), and facilitated client success (3.6%).

4. Discussion

To review, the purposes of this study were to examine the exact self-disclosure statements AWS use, to determine when and how AWS disclose their stuttering, to explore other aspects of identity AWS may disclose, and to define the methods/process clinicians use in formulating self-disclosure statements in session.

4.1. AWS questionnaire

The results from this study indicate that most AWS participants use a direct or educational verbatim self-disclosure statement. Byrd, McGill et al. (2017) reported that listener perceptions were most positively influenced by informative self-disclosure statements. The results of the current study demonstrate that AWS appear to be using self-disclosure statements which result in the most positive listener effects. However, in the current study, it is unclear if the motivation for AWS using a direct or educational self-disclosure statement is to elicit positive listener reactions or for some type of self-benefit.

Interestingly, there was a noticeable difference between participant verbatim responses as compared to their fixed choice selection of self-disclosure statements. The majority of participants (53%) in the verbatim response reported that they use a type of educational statement to self-disclose their stuttering, but when asked to select between three options of statements, only 10.8% of participants selected the educational statement. For example, a participant may have provided a verbatim response that was considered by coders to be educational in nature; however, when asked which of the fixed-choice responses they identified with the most, the educational style self-disclosure statement may not have resonated with them. Thus, yielding a disparate result between verbatim and fixed-choice responses in the questionnaire. Given the inherent difference between fixed-choice and open-ended questions, it is not surprising that participants in the current study provided different answers to these types of questions (Hruschka et al., 2004). Zaller and Feldman (1992) reported that when participants are surveyed, an open-ended question style may yield more authentic responses. In the current study, participants may not have identified with the fixed-choice response representing an educational self-disclosure statement, yet in the verbatim condition they supplied an answer that was more authentic.

In addition to the type of disclosure statement, the majority of participants reported that they self-disclose in job interviews, when meeting new friends, and when speaking on the telephone. Omarzu (2000) described a Disclosure Decision Model (DDM) which outlines the benefits and consequences of self-disclosing in various social interactions. Applying the DDM to the current study, participants reported that they are more likely to self-disclose in situations that carry high social risks with the possibility of high social rewards.

Participants also reported that they were more likely to use a self-disclosure statement at the beginning of an interaction. Healey et al. (2007) reported that listeners were more likely to positively rate speakers who self-disclosed their stuttering at the beginning of an interaction compared to the end of an interaction. Again, AWS in the current study appear to be using self-disclosure statements at times during an interaction which result in the most positive listener effects.

When AWS in the current study were asked about disclosing other aspects of their lives (e.g., mental health disorder, death of a family member), the majority reported that they do disclose these aspects and that they use simple, direct statements. Kelly and Robinson (2011) surveyed 192 LGBTQ adults with communication impairments about self-disclosure. They reported that despite participants feeling that it was important, the majority did not disclose to clinicians their membership in the LGBTQ community due to fear of discrimination and that disclosing may even negatively impact the quality of services they receive. Kelly and Robinson’s results may explain why participants in the current study who had the experience of disclosing other aspects of their identity may also disclose using direct statements as compared to educational statements that may require a higher level of intimacy or motivation.

4.2. SLP questionnaire

Results from the SLP questionnaire provide information about how clinicians approach self-disclosure with their clients, what types of statements their clients may use to disclose, and why clinicians feel that self-disclosure is relevant to their practice. Specifically, SLPs reported that their clients use educational disclosure statements, and that their clients’ use of self-disclosure is individualized and dependent upon the communicative situation and partner. This finding is supported by the verbatim responses from AWS questionnaire, in which the majority of AWS reported using self-disclosure statements that were coded as educational in nature. Additionally, the SLP report of their clients developing and using individualized self-disclosure statements is consistent with ASHA’s position of providing patient-centered, individualized care (ASHA, 2004).

When asked about how they approached the development of self-disclosure statements, a majority of SLPs reported that they would brainstorm and/or discuss with their clients the idea of control and/or ownership of their stuttering. Again, this finding is in line with ASHA (2004) preferred practice recommendations which state that SLPs should provide sensitive and knowledge-based treatment with care to address individual clients’ preferences and needs.

Finally, the SLP participants were asked why they found creating self-disclosure statements with their clients applicable in their intervention. The majority of SLPs responded that self-disclosure statements are self-empowering, and AWS can increase acceptance of their stutter, own/control it, advocate for themselves, and gain confidence by disclosing.

4.3. Limitations and future directions

Limitations of the current study relate to recruitment and methodology. Given the small sample size, these participants’ responses may not be representative of the broader stuttering community’s use of self-disclosure statements. Since this was a web-based questionnaire, participation was self-selecting in nature, which may have limited the diversity of both AWS and SLPs with respect to viewpoints of self-disclosure. Recruitment included AWS who were currently engaged in clinical services for stuttering, as well as those who may attend stuttering support groups such as the National Stuttering Association (NSA) chapter meetings or PassingTwice. Thus, the nature of participant recruitment may have skewed the participant sample with respect to their exposure and experience with the topic of self-disclosure.

Additionally, this study did not explore the use of nonverbal (e.g., wearing a NSA t-shirt) and other methods of self-disclosure (e.g., voluntary stuttering). Instead, the focus of the current investigation was use of verbal self-disclosure statements. Future studies should investigate the generation and use of a variety of self-disclosure methods, including voluntary stuttering and implicit disclosure.

The current study asked AWS if they use self-disclosure statements and in what contexts, but did not inquire about the rationales for doing so. Future research should explore the rationale that AWS have for using self-disclosure statements. Why do AWS choose to use direct, educational, or apologetic statements? A greater understanding of why AWS use certain types of self-disclosure statements would be of value to SLPs who are working collaboratively with their clients to implement this strategy in their lives.

Finally, the current study explored the relationship between gender and self-disclosure, but it would have been strengthened by exploring the intersectionality of gender, race, age, socioeconomic status, background, and stuttering. Specifically, future research should collect a range of demographic variables and responses about how the participants perceive these variables to impact their use of self-disclosure statements.

5. Conclusion and recommendations

This qualitative study (1) analyzed the verbatim wording used by adults who stutter (AWS) to self-disclose their stuttering, (2) determined the contexts in which AWS may use a self-disclosure statement, (3) examined the use of self-disclosure by AWS about other aspects of their life in addition to stuttering, and (4) investigated the ways in which SLPs develop self-disclosure statements with their adult clients who stutter. The majority of AWS responded with verbatim self-disclosure statements that were coded as educational. When asked to select from pre-written self-disclosure statements, the majority of participants selected a direct statement. Relating to contextual use of self-disclosure statements, the majority of participants reported that they self-disclose their stuttering when interviewing for a job. Lastly, AWS reported that they use direct statements to self-disclose about other aspects of their identity/life.

The SLP questionnaire results indicated that most SLPs coach their clients to use educational self-disclosure statements. Many SLPs reported that they use an individualized approach to brainstorming self-disclosure statements. Finally, SLPs reported that they find self-disclosure useful and beneficial because it provides AWS with self-empowerment.

Given these results, our recommendations to clinicians who work with AWS are as follows:

1. In generating a self-disclosure statement with your clients, it may be helpful to share that other AWS report using a straightforward or educational, non-apologetic statement at the beginning of an interaction to inform listeners about their stuttering.

2. Formulation of self-disclosure statements should be collaborative between the AWS and SLP. Self-disclosure statements should be individualized and based on the client’s communicative setting and partners.

Biography

Megann McGill, Ph.D., CCC-SLP, is an assistant professor in the Department of Speech and Hearing Sciences at Portland State University. She researches stuttering, bilingualism, and telepractice treatment for stuttering.

Jordan Siegel, B.F.A., is a second-year graduate student in the Department of Speech and Hearing Sciences at Portland State University. He has presented on topics related to stuttering and telepractice at the Oregon Speech-Language-Hearing Association and American Speech-Language-Hearing Association Conferences.

Denise Nguyen, B.A., is a second-year graduate student in the Department of Speech and Hearing Sciences at Portland State University. Her research and clinical interests include fluency disorders and telepractice. She is a co-founder and co-director of CHAT Retreat, a weekend retreat for adults who stutter in the Pacific Northwest.

Sulema Rodriguez is an undergraduate student at Portland State University. She is also an NIH Build EXITO scholar and is currently an intern at the NIH working with Dr. Dennis Drayna. Her research interests include the psychosocial and biological components of stuttering.

Appendix A. Web-based questionnaire for adults who stutter

1. I am a:

   1. Person who stutters
   2. Speech-language pathologist
2. What is your age?

   1. 18–24 years old
   2. 25–34 years old
   3. 35–44 years old
   4. 45–54 years old
   5. 55–64 years old
   6. 65–74 years old
   7. 75 years or older
3. What is your gender?

   1. Male
   2. Female
   3. Genderqueer
   4. Non-binary (including genderfluid & gender non-conforming)
   5. Trans man
   6. Trans woman
   7. Gender not listed
   8. Prefer not to answer

4. What do you think is the cause of your stuttering?__________________

5. At what age did you begin stuttering?

   1. 0–3
   2. 4–5
   3. 6–7
   4. 8–9
   5. 10–11
   6. 12+
6. Do you present with any physical concomitants I secondary behaviors during a moment of stuttering (e.g., eye blinks, tics, tremors of the lips or face, jerking of the head, breathing movements, or fist clenching)?

   1. Yes
   2. No
7. Please identify the physical concomitants I secondary behaviors (can check multiple boxes):

   1. White
   2. Hispanic or Latino
   3. Black or African American
   4. Native American or American Indian
   5. Asian / Pacific Islander
   6. Other:____________________

8. What state are you from?

9. What city are you from?

10. What is the highest degree or level of school you have completed? If currently enrolled, highest degree received.

    1. No schooling completed
    2. Nursery school to 8th grade
    3. Some school, no diploma
    4. High school graduate, diploma or the equivalent (for example: GED)
    5. Some college credit, no degree
    6. Trade/technical/vocational training
    7. Associate’s degree
    8. Bachelor’s degree
    9. Master’s degree
    10. Professional degree
    11. Doctoral degree
    12. Other:______________
11. Is English your first / native language?

    1. Yes
    2. No
12. What is your native / primary language?

    1. Spanish
    2. Mandarin
    3. Cantonese
    4. Tagalog
    5. Vietnamese
    6. French
    7. Korean
    8. German
    9. Italian
    10. Other:__________________

Appendix B. Web based questionnaire for speech-language pathologists

1. I am a:

   1. Person who stutters
   2. Speech-Language Pathologist
2. In what setting do you primarily work?

   1. School
   2. Clinic
   3. Private Practice
   4. Hospital
   5. Rehab Center
   6. Other:____________________
3. How many clients/patients do you typically see per week?

   1. 0–10
   2. 10–2-
   3. 20–30
   4. 30+
4. Do you primarily work with:

   1. Monolinguals
   2. Multilinguals
   3. Both
5. Of the clients on your case load, what percentage are individuals who stutter?

   1. 0%
   2. 1–10%
   3. 11–20%
   4. 21–30%
   5. 31–40%
   6. 41–50%
   7. 51–60%
   8. 61–70%
   9. 71–80%
   10. 81–90%
   11. 91–100%
6. Do you primarily work with:

   1. Adults who stutter
   2. Children who stutter
   3. Both
7. What techniques do you typically employ in your intervention with persons who stutter?

   1. Fluency Shaping (e.g., easy onset, easy relaxed smooth articulatory touch)
   2. Stuttering modification (e.g., cancellation, pull-out, preparatory set)
   3. Avoidance reduction therapy
   4. Voluntary Stuttering
   5. Self-disclosure
   6. Other:_________________________
8. Given the definition of a self-disclosure statement (Self-disclosure is the act of revealing information about yourself to another person. Specific to stuttering, self-disclosure is the process of informing a communication partner that you are a person who stutters), have you heard of using this strategy as it relates to stuttering?

   1. Yes
   2. No

9. What do they say for their self-disclosure statement?__________________________

10. In your clinical practice, do you help develop a self-disclosure statement with your clients who stutter?

    1. Yes
    2. No

11. How do you approach developing a self-disclosure statement?________________

12. Why do you find a self-disclosure statement applicable in your intervention?______________

13. In what state do you currently practice?

14. Which city?

15. Where did you obtain your Master’s and/or Doctoral degree?__________________